The placenta succenturiata or, succenturiate placenta is an abnormality of placenta having succenturiate lobe. The term succenturiate derives from the Latin word "succenturio" meaning "to substitute". Succenturiate lobe is one or, more small accessory placental lobe, size of a cotyledon which develops in the membranes at a distant from the periphery of the main placental disc usually having vascular connections of fetal origin which runs through the membranes connecting main placenta to the succenturiate lobe. The accessory lobe is developed from the activated villi on the chorionic leave. Its overall incidence is approximately 3 per 1000 pregnancies. Most of the succenturiate lobe have vasa praevia. This placental anomaly is noted mostly in elderly pregnant females and who have undergone in vitro fertilization (IVF). This rare entity might complicate the pregnancy and risk the life of mother as well as fetus. Succenturiate lobes of placenta are associated with retained placenta and hence postpartum infection and hemorrhage. The succenturiate placenta is a morphological abnormality, the ultrasonography guided recognition of which in the antenatal period is important. Accompanying vasa praevia might cause fetal hemorrhage at delivery.

A 35-year-old female with routine antenatal checkup having and uneventful present pregnancy, presented to our emergency at term with pain in lower abdomen. She had previous normal vaginal delivery. Examination revealed stable vitals (pulse 90/min, regular, blood pressure 126/84 mmHg, supine), other systemic examination were normal. After proper internal examination, she was admitted in the labor room where she delivered a 3kg healthy female baby. Subsequently, the placenta was delivered out by controlled cord traction. The placenta on being thoroughly examined was found to be intact. It had a small accessory lobe, a size of a cotyledon in the membranes at a distance from the main placenta. This accessory lobe had vascular connections with the main placenta. No other abnormality was detected in the placenta itself and the umbilical cord (Figure 1) and (Figure 2). There was no incidence of excessive bleeding per vaginal infection. The postpartum period was uneventful in terms of mother and baby and she was discharged on the third postpartum day. Patient and her baby is doing well after two years follow-up.

Placental abnormalities are an uncommon obstetric finding and among them the succenturiate lobe of placenta is a very rare entity which is common in elderly pregnant women aged more than thirty five [1]. it is encountered mostly in complicated pregnancies which might result infetal death [2]. This rare entity is usually missed by transabdominal ultrasound [3]. Hence, thorough examination of the cotyledons of placenta after delivery is of utmost importance to document this rare variety of placenta. In singleton pregnancies, the incidence of placental complications such as placental abruption, vasa praevia and retained placenta were observed to be associated with the presence of abnormally shaped placentae [4]. Succenturiate lobes of placenta are associated with retained placenta and there is an increased incidence of postpartum infection and hemorrhage with this placental anomaly [5]. This case is a unique presentation of a succenturiate lobe of placenta in an elderly pregnant woman which remained undiagnosed even after periodic antenatal ultrasound examinations of the placenta. Also in our case there was no untoward complication to the mother or baby which is much more commonly reported in women having succenturiate lobes of placenta.

The succenturiate placenta is a morphological abnormality, the ultrasonography guided recognition of which in the antenatal period is important. This is due to the fact that the vessels connecting the main placenta with the succenturiate lobe may rupture during labor and lead to fetal demise. In addition, retained placental material may lead to primary as well as secondary postpartum hemorrhage. Later on it may lead to uterine sepsis and sub involution. Accompanying vasa praevia might cause dangerous fetal hemorrhage at delivery. There is mild risk of placental abruption also. However, there is no increased risk of fetal deformities.

1. Suzuki S, Igarashi M. Clinical significance of pregnancies with succenturiate lobes of placenta. Arch Gynecol Obstet 2008 Apr;277(4):299–301.   [CrossRef]   [Pubmed]    
2. Seleye-Fubara D, Akani CI. Succenturiate placenta: A rare variant in Rivers State Nigeria (a report of one case). Niger J Med 2005 Jul-Sep;14(3):325–6.   [Pubmed]    
3. Shukunami K, Tsunezawa W, Hosokawa K, Tajima K, Kotsuji F. Placenta previa of a succenturiate lobe: A report of two cases. Eur J Obstet Gynecol Reprod Biol 2001 Dec 1;99(2):276–7.   [CrossRef]   [Pubmed]    
4. Suzuki S, Igarashi M, Inde Y, Miyake H. Abnormally shaped placentae in twin pregnancy. Arch Gynecol Obstet 2010 Jan;281(1):65–9.   [CrossRef]   [Pubmed]    
5. Suzuki S, Igarashi M. Clinical significance of pregnancies with succenturiate lobes of placenta. Arch Gynecol Obstet 2008 Apr;277(4):299–301.   [CrossRef]   [Pubmed]